A STUDY TO ASSESS THE EFFECTIVENESS OF

STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE

REGARDING CARDIO PULMONARY RESUSCITATION
AMONG DEGREE STUDENTS IN A SELECTED
COLLEGE,KOMARAPALAYAM
By
301312902
Dissertation submitted to

The Tamilnadu Dr.M.G.R. Medical University, Chennai,

In partial fulfillment of the requirements for the degree of

Master of Science
In
Medical Surgical Nursing (Cardio Vascular and Thoracic
Nursing)
under the guidance of
Prof.Mrs. M. LATHA, M.Sc(N),M.B.A,Ph.D.,
Principal
Department of Medical Surgical Nursing

ANBU COLLEGE OF NURSING

M G R NAGAR, KOMARAPALAYAM,
NAMAKKAL DIST, TAMIL NADU.
OCTOBER - 2015
 A STUDY TO ASSESS THE EFFECTIVENESS OF
STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE
REGARDING CARDIO PULMONARY RESUSCITATION
AMONG DEGREE STUDENTS IN A SELECTED
COLLEGE,KOMARAPALAYAM

Approved by: ANBU COLLEGE DISSERTATION COMMITTEE.

RESEARCH GUIDE …………………………………………

Prof.Mrs. M. LATHA, M.Sc(N),M.B.A,Ph.D.,

HOD of Medical Surgical Nursing,

Anbu College of Nursing

Komarapalayam.

PRINCIPAL ……………………………………………………………

Prof.Mrs. M. LATHA, M.Sc(N),M.B.A,Ph.D.,

Principal

Anbu College of Nursing

Komarapalayam.

A DISSERTATION SUBMITTED TO THE TAMIL NADU DR. M.G.R.

MEDICAL UNIVERRSITY, CHENNAI. IN PARTIAL FULFIL LMENT OF
THE REQUIREMENT FOR THE DEGREE OF MASTER OF SCIENCE IN
NURSING.

VIVA VOCE:

INTERNAL EXAMINER: …………………………………………

EXTERNAL EXAMINER: …………………………………………

 ENDORSEMENT BY HEAD OF THE INSTITUTIONS.

This is to certify that the dissertation entitled “A STUDY TO ASSESS THE

EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON

KNOWLEDGE REGARDING CARDIOPULMONARY RESUSCITATION

AMONG DEGREE STUDENTS IN A SELECTED COLLEGE,

KOMARAPALAYAM.” Is a bonafide research work done by Ms.ANBU EPSI.J.

under the guidance of Prof.M.LATHA,M.Sc(N),M.B.A,Ph.D.,HEAD OF THE

DEPARTMENT OF MEDICAL SURGICAL NURSING.

PRINCIPAL.
ACKNOWLEDGEMENT
 ACKNOWLEDGEMENT

“Leave your life to god, who prompts act and made it possible dedicate the act, the

will and the wish all to god almighty.”

First of all I would like to praise and glory to the God almighty, which is the

source, strength and inspiration to every walk of my life.

I render my sincere thanks to Shri. S. Srinivasan, Chairman of Anbu

Educational Institutions, who gave this opportunity to complete my master degree in

this esteemed institution.

It is my privilege to express my heartfelt thanks to

Prof. M.Latha, M.Sc (N), M.B.A, Ph.D., Head of Medical Surgical Nursing,

Principal, Anbu College of Nursing, for the encouragement, inspiration ,support as

well as for providing all facilities for successful completions of this study.

I express my grateful thanks to Mrs. K.Vijayalakshmi.M.Sc (N), Vice-

Principal and Class Co-Ordinator, who has given precious advice, valuable

suggestions, and guidance for the completion of thesis in a stipulated period.

I deeply extend my thanks to Mrs. R.Gowri, M.Sc (N), Assistant Professor,

Medical Surgical Nursing Department for her valuable suggestions, advice and

guidance to carry out the study in a given period of time.

I extend my thanks to Mrs.G.Juliet Nirmala Mary, M.Sc (N)., Assistant

Professor, Medical Surgical Nursing Department for her valuable suggestions and

guidance throughout the study.

 I sincere gratitude to all PG Faculties for their guidance and constant

motivation throughout the study.

I owe my special gratitude to Dr.Senthilraj, Principal, Anbu Arts and

Science College, for his valuable guidance, encouragement and for his extended arm

of help throughout my study.

I wish to express my sincere thanks to Mrs.Aishwarya, Biostatistician, in

carrying out the statistical analysis of the data.

I render my thanks to all the experts who validated tools and provided

constructive and valuable opinions.

I also accord my respect and gratitude to all the UG faculties & office staff of

Anbu College of Nursing for their timely assistance, co-operation and support

throughout the period.

My sincere thanks to all my friends and beloved juniors for their constant

help, ideas and for standing with me during the odds.

I owe my heartfelt gratitude to my parents Mr.J.Joshua, Mrs.Beaula, My

brother Mr.J.Ravi Kumar, My sister J.Kiruba for their prayer, constant support and

ever memorable help throughout this study.

Last but not least; I would sincerely thank all the members and colleagues who

have directly or indirectly helped me in the successful completion of the study.

 ABSTRACT

STATEMENT OF THE PROBLEM:

An evaluative study to assess the effectiveness of structured teaching

programme on knowledge regarding Cardio Pulmonary Resuscitation among

degree students in selected colleges, Komarapalayam was conducted by as a

partial fulfillment of the requirements for the degree of Master of Science in

nursing at Anbu college of nursing, Komarapalayam affiliated to the Tamil nadu

Dr.M.G.R. Medical University, Chennai.

OBJECTIVES:

1. To assess the knowledge level regarding cardio pulmonary resuscitation

among degree students in selected colleges.

2. To find out the relationship between pretest and posttest knowledge score

regarding CPR among degree students.

3. To find out the association between knowledge regarding cardio

pulmonary resuscitation among degree students with selected socio

demographic variables.

HYPOTHESES:

On the basis of the objectives the following hypotheses have been formulated:

H1: There will be a significant difference between pretest and post test

knowledge score regarding cardio pulmonary resuscitation.

H2: There will be a significant association between the knowledge with

selected demographic variables of the degree students (such as age, sex, religion,

previous information regarding cardio pulmonary resuscitation).

METHOD OF STUDY

Conceptual framework for the study was based on the open system theory of

J.W.Kenny’s. Research design used for this study was quasi experimental one group

pre test and post test design. The study was conducted in Anbu Arts and Science

College, Komarapalayam.. The population for this study was degree students.

Purposive sampling technique was used to select the sample.

Data collection tool consisted of demographic variables, questionnaire

regarding Anatomy and Physiology of Heart, Cardiac arrest and CPR to assess the

level of knowledge among degree students.

The content validity of the tool was done by 5 experts in different fields.

Reliability was obtained by Karal Pearson’s method, the score was r=0.9 which was

highly reliable. Pilot study was conducted in Anbu arts and Science College (other

department) to find out the feasibility of conducting the study.

The collected data was tabulated, analyzed and interpreted by using

descriptive and inferential statistical methods.

FINDINGS:

Major findings of the study were regarding the effectiveness of STP on the

level of Knowledge. The obtained‘t’ value is 20.66 .Hence the null hypothesis was

rejected.

There was significant association was found between knowledge

scores of degree students regarding Cardiopulmonary Resuscitation with their

demographic variables such as Source of information (P<0.05). No significant

association was found between knowledge scores of degree students regarding

Cardiopulmonary Resuscitation with their demographic variables such as

age,sex,father’s education, mother’s education, residential area, type of family,

previous knowledge, group studied in XII(P>0.05). The stated hypothesis was

accepted.

Based on the findings, the implication and recommendations were drawn.

 TABLE OF CONTENTS

SL.NO. CONTENTS PAGE

NO.

I INTRODUCTION 1-14

II REVIEW OF LITERATURE 15-29

III METHODOLOGY 30-37

IV DATA ANALYSIS AND INTERPRETATION 38-59

V DISCUSSION AND SUMMARY 60-64

BIBLIOGRAPHY 65-67

ANNEXURE
 LIST OF TABLES

Table Titles Page

No.
No.
4.1 Frequency and percentage distributions according to the 40
demographic variables

4.2 Area wise Distribution of mean, Standard deviation and 53

mean percentage of pretest knowledge scores of the CPR
among degree students.

4.3 Level of knowledge of students of CPR 54

4.4 Area wise comparison of mean, standard deviation and 56

mean percentage of pre and post test knowledge scores of
degree students regarding CPR
4.5 Comparison between difference of pre and posttest 57
knowledge of degree students regarding
Cardiopulmonary Resuscitation
4.6 Association between the selected demographic variables 58
with the levels of knowledge among degree students.
 LIST OF FIGURES

SL.NO. Figures Page

No.
1 Conceptual Framework 14

2 Schematic representation of the study design 37

3 Bar diagram showing age distribution of degree students 43

4 Pie diagram showing sex distribution of degree students 44

5 Pie diagram showing father’s educational status of degree 45

students
6 Pie diagram showing mother’s educational status of degree 46
students
7 Pie diagram showing residential area distribution of degree 47
students
8 Pie diagram showing type of family distribution of degree 48
students
9 Cone diagram showing religion distribution of degree students 49

10 Pie diagram showing distribution of previous knowledge of 50

degree students
11 Bar diagram showing distribution of source of information 51

12 Pyramid diagram showing distribution of group studied in XII 52

13 Bar diagram showing level of knowledge of students 55

CHAPTER-I

INTRODUCTION

CHAPTER-I
INTRODUCTION:

“AN UNEXAMINED LIFE IS NOT WORTH LIVING”

x SOCRATES

The heart is the center of cardiovascular system and it is vitally responsible for

just about everything that gives body life ranging from the transportation of oxygen to

the success of the immune system. However, the foods we eat and the amount of

activity choose to take part in dramatically affect the overall health of the heart and

the many other tissues that make up cardiovascular system.

The heart is a muscular organ about the size of a closed fist that functions as

the body’s circulatory pump. It takes in deoxygenated blood through the veins and

delivers it to the lungs for oxygenation before pumping it into the various arteries

(which provide oxygen and nutrients to body tissues by transporting the blood

throughout the body).

Each year, a number of persons suffer with an accident or illness, severe

enough to stop their breathing and leads to respiratory arrest. In a small number of

these cases, it will even stop their heart beating and leads to cardiac arrest. Sudden

cardiac arrest is a major cause of death in developed countries. Sudden death occurs

when heartbeat and breathing stops.

The other common causes of sudden death include heart attack, electrical

shock, drowning, choking, suffocation, trauma, drug reactions, and allergic reactions.

The best chance of ensuring their survival is to give them emergency treatment known

as cardiopulmonary resuscitation (CPR).

 CPR can consist of many different things, but the initial, vital part is Basic

Life Support (BLS).Cardio means “of the heart” and pulmonary means “of the

lungs”. Resuscitation is a medical word that means “to revive” or bring back to life.

Sometimes cardio pulmonary resuscitation (CPR) can help a person who has stopped

breathing, and whose heart may have stopped beating, to stay alive. Despite advances

in cardiopulmonary resuscitation (CPR) methods, including the introduction of the

automatic electrical defibrillator (AED) and therapeutic hypothermia, only about 10

% of adult out-of-hospital cardiac arrest (OHCA) victims survive to hospital

discharge, and the majority of survivors have moderate to severe cognitive deficits 3

months after resuscitation.

Resuscitation from cardiac arrest is the ultimate whole body ischemia-

reperfusion (I/R) injury affecting multiple organ systems including brain and heart.

In most cases, defibrillation and other means of advanced life support are not

immediately available. In urban settings it takes an average of nearly ten minutes for

professional help to arrive. During this time victims can only rely upon CPR

provided by educated bystanders. Therefore a substantial burden of responsibility lies

on the shoulders of educators who need to pass on their knowledge and skills of CPR

to their trainees in a way simple enough to be remembered and recalled rapidly in a

highly stressful moment. It has been shown that correctly performed bystander CPR

may positively influence short and long- term survival of cardiac arrest victim.

Every nurse and physician should be skilled in CPR because cardiac arrest, the

sudden cessation of breathing, and adequate circulation of blood by the heart, may

occur at any time or in any setting. Resuscitation measures are divided into two

components, basic cardiac life support and advanced cardiac life support. The

American Heart Association establishes the standards for CPR and is actively
involved in teaching BCLS and ACLS to health professionals. The American Heart

Association recommends that nurses and physicians working with patients be certified

in BCLS and ACLS. CPR alone is not enough to save lives in most cardiac arrest. It

is a vital link in the chain of survival that supports the victim until more advanced

help is available. The chain of survival is composed of the following sequence: early

activation of the EMS system, early CPR, early defibrillation and early advanced care.

Recommending that chest compressions be the first step for lay and

professional rescuers to revive victims of sudden cardiac arrest, the association said

the A-B-Cs (Airway-Breathing-Compressions) of CPR should now be changed to C-

A-B (Compressions-Airway-Breathing).For more than 40 years, CPR training has

emphasized the ABCs of CPR, which instructed people to open a victim’s airway by

tilting their head back, pinching the nose and breathing into the victim’s mouth, and

then giving chest compressions. This approach was causing significant delays in

starting chest compressions, which are essential for keeping oxygen-rich blood

circulating through the body. Changing the sequence from A-B-C to C-A-B for adults

and children allows all rescuers to begin chest compressions right away.

People who handle emergencies such as police officers, firefighters,

paramedics, doctors and nurses are all trained to do CPR. Many other teens and

adults like lifeguards, teachers, child care workers, and may be even your mom or dad

know how to do CPR too. Many people may think you need to get a degree to get a

healthcare job, but the truth is many jobs simply require applicants to be CPR and

First Aid certified Courses to receive certification in CPR and First Aid are offered at

colleges, technical schools, and Red Cross facilities across the country. This makes

getting certified easy and very accessible to anyone. People can get both

certifications as young as 16 years of age. This means they can start getting credible
work experience at an earlier age, which will only help them out more down the road.

And since the courses are so short, it does not have to interfere with high school.

NEED FOR THE STUDY

CPR is a rescue procedure to be used when the heart and lungs have stopped

working. There is a wide variation in the reported incidence and outcome for out of

hospital cardiac arrest. These differences are due to definition and ascertainment of

cardiac arrest as well as differences in treatment after its onset.

Several authors described the problem of poor performance in CPR, even

when provided by medical professionals. Numerous investigations have reported the

problem of poor skills retention after various CPR courses. Studies reporting the need

for improvement of resuscitation techniques led to the recent changes in BLS and

ALS algorithms.

Dangers of Sudden Cardiac Arrests (SCA) that can lead to death of an

individual within a few minutes. As per WHO census statistics mortality due to

cardiac arrest approximately 4280 out of every one lakh people die every year from

SCA in India alone. After a cardiac arrest there are four to six minutes before brain

death and death occur. Chances of survival reduce by 7-10 percent with every passing

minute. It is a silent epidemic. Cardiac arrest is reversible if the victim is administered

prompt and appropriate emergency care. This generally involves administration of

cardiopulmonary resuscitation (CPR), shock treatment to the chest to reset the heart's

rhythm (defibrillation) and advanced life support.

In India the annual incidence of sudden cardiac death accounts for 0.55 per

1000 population. The survival rate of a sudden cardiac arrest is almost less than 1%.
Sudden cardiac death constitutes 40-45% of cardiovascular deaths and out of this

almost 80% are due to heart arrhythmia disturbances or arrhythmia.

Maximum arrests were because of cardio respiratory arrests. Immediate

survivors were 5 out of 6 (83.3%), out of 5 patients only 2 were alive at the end of 24

h (40%), and none of them survived to be discharged. Overall survival to hospital

discharge was 3.8% (1.7-13%) of a 3,220 pooled patient group. Analysis of their

functional recovery found good outcome in 86.7% (44-89%), moderate impairment in

10.2% (8.5-44%) and severe impairment in 3.1% (2-36%) of survivors from a cohort

of 1679 pooled patients. Although, survival from prehospital arrest is diminished in

geriatric groups, those who survive often have good functional recovery.

Heart disease is the world’s largest killer, claiming 17.5 million lives every

year. About every 29 seconds, an Indian dies of heart problem. As many as 20,000

new heart patients develop everyday in India, six core Indians suffer from heart

disease and 30 percent more are at high risk. The risk of sudden cardiac death from

coronary artery disease in adults is estimated to be 1 per 1,000 adults 35 years of age

and older per year. About 75 percent to 80 percent of all out-of-hospital cardiac

arrests happen at home. Hence, being trained to perform CPR can make the difference

between life and death for a victim.

Each year almost 330,000 peoples die from heart disease. Half of these will

die suddenly, outside of the hospital because their heart stops beating. The most

common cause of death from heart attack in adult is a disturbance in the electrical

rhythm of the heart or ventricular fibrillation. It can be treated by applying an

electrical shock to the chest. One way of buying time until a defibrillator becomes

available is to provide artificial breathing and circulation by performing CPR.

 Over one million heart attacks happen every year and more than 20% of

people die before ever reaching a hospital. Latest data shows that cardiac arrest is

becoming the number one cause of death. In fact, studies show that 80% of all

cardiac arrests happen at home which will most likely be a family member or friend.

Coronary artery disease (CAD) was observed in 66 (38%) and acute

myocardial infarction documented in 30 (17%). At least 1 of 3 CAD risk factors –

hypertension, diabetes, or smoking was observed in 80.6%. Proportion of subjects

with at least one risk factor for CAD was similar in the age groups above and below

50 years (67.6%).

Cardio pulmonary Resuscitation has been used extensively in the hospital

setting since its introduction over 3 decades ago. Provision of adequate chest

compressions remains a standard of care for optimal outcome in cardiopulmonary

arrest. Given the recent changes to CPR rates and a greater emphasis on pushing

faster and deeper, this has raised questions surrounding rescuer fatigue and efficacy of

compressions. While a body of work has been undertaken on previous CPR rates and

associated fatigue levels, there is a shortage of literature on the latest CPR rates and

associated rescuer fatigue in the hospital and prehospital settings

Provision of adequate chest compressions remains a standard of care for

optimal outcome in cardiopulmonary arrest. Given the recent changes to CPR rates

and a greater emphasis on pushing faster and deeper, this has raised questions

surrounding rescuer fatigue and efficacy of compressions. While a body of work has

been undertaken on previous CPR rates and associated fatigue levels, there is a

shortage of literature on the latest CPR rates and associated rescuer fatigue in the

hospital and prehospital settings

 In April 2008, the American heart association took steps to simplify the

process of helping victims of cardiac arrest by introducing “hands only” CPR. About

one third of people who suffer a cardiac arrest at home or at a public place actually

receive help, bystanders could be afraid to initiate CPR for fear that they will do

something wrong or won’t know what to do. Others may be reluctant to perform

mouth to mouth breathing for fear of contracting an infection. The American heart

association proposed the new guidelines in order to allow bystander who have not

been trained in conventional CPR or who may fear making mistake a way to offer

help.

Survival in hospital and they reviewed that CPR records, 44% of the patient

initially survived following CPR, and the 1 –year survival rate was 5% patients with

shorter durations of CPR and those administered fewer procedures and medications

during CPR survival longer than patients with prolonged CPR. Knowledge of the

likelihood of survival following CPR for subgroups of the hospital population based

on prearrest and intra arrest factors can help patients, their families, and their

physicians decide with compassion and conviction, in what situations CPR should be

administered.

Patients defibrillated at an early stage among the non-monitored patients had

a survival rate similar to the corresponding group in monitored areas. Many

institutions have a one-tiered defibrillation system, in which defibrillation is delivered

once the CPR or ACLS team arrive. The CPR team brings a manual defibrillator with

them, or manual defibrillators are placed around the institution so that one can be

brought to the scene for use by the advance team. Bystander CPR (comprising airway

opening, rescue breathing, and chest compressions: combined with rapid call for

ambulance response) improves survival rates from cardiac arrest 2-3 fold.
 Various studies suggest that in out-of-home cardiac arrest, bystanders, lay

persons or family members attempt CPR in between 14% and 45% of the time, with a

median of 32%. Internationally, rates of bystander CPR reported to be as low as 1%

and as high as 44%. However, the effectiveness of this CPR is variable, and the

studies suggest only around half of bystander CPR is performed correctly. A recent

study has shown that members of the public having received CPR training in the past

lack the skills and confidence needed to save lives. These experts believe that better

training is needed to improve the willingness to respond to cardiac arrest.

In the light of above, the investigator found it is desirable to assess the

knowledge and skill in CPR technique among the degree students and also to update

the knowledge and improvement in skill. The way to learn CPR is to practice CPR.

Educating the students and creating awareness in helping them to learn more about

CPR and it help to prevent death occurring due to cardiac arrest. Early initiation of

CPR improves the chance of successful resuscitation and survival.

STATEMENT OF THE PROBLEM

“A study to assess the effectiveness of structured teaching programmes on

knowledge regarding cardio pulmonary resuscitation among degree students a in

selected college, Komarapalayam”.

OBJECTIVES

• To assess the knowledge level regarding cardio pulmonary resuscitation

among degree students in selected colleges.

• To evaluate the effectiveness of structured teaching programme on knowledge

regarding cardio pulmonary resuscitation among degree students in selected

colleges.
 • To find out the association between knowledge regarding cardio pulmonary

resuscitation among degree students with selected socio demographic

variables.

OPERATIONAL DEFINITION

Assess: It is the organized, systematic and continuous process of collecting

data from the degree students regarding cardio pulmonary resuscitation.

Effectiveness: It refers to the extent to which the structured teaching

programme on cardio pulmonary resuscitation has improved the knowledge of

students after the implementation of the structured teaching programme as

evidenced by the differences in the pretest and post test.

Structured Teaching Programme: It refers to systematically developed

Instruction designed to provide information regarding cardio pulmonary

resuscitation to degree students.

Cardio pulmonary resuscitation: it is a simple technique used to restore and

maintain breathing and circulation in cardiac arrest victims.

Knowledge: The sum of what is known regarding cardio pulmonary

resuscitation.

Degree students: who are undergoing the degree (B.A.English) in a selected

college.

HYPOTHESIS

H1: There will be a significant difference between pretest and post test

knowledge score regarding cardio pulmonary resuscitation.

 H2: There will be a significant association between the knowledge with

selected demographic variables of the degree students (such as age, sex, religion,

previous information regarding cardio pulmonary resuscitation).

ASSUMPTION

• Most of the degree student may have some knowledge regarding

cardio pulmonary resuscitation.

• There will be enhancement in the knowledge of the degree students

after administration of STP.

LIMITATION

The study was conducted to those who were,

• available during data collection period

• in the age group of 19-22 yrs.

• willing to participate with study

• able to read and write English

THEORETICAL FRAME WORK

Theoretical framework provides closed description of variables suggesting

ways or method to conduct the study and guiding the interpretation, evaluation and

integration of study finding stated that (Wood and Harber, 1994).

Theoretical Framework for this study was based on open system theory of

J.W.Kenny’s (1998). In this main focus is on the part and their interrelationship which

makeup and describe the whole. He defined system ‘as a complex interaction which

means the system consists of two or more converted elements which form an

organized whole.

In the present study, degree students considered as a system with the elements

with variable factors related knowledge regarding CPR, which interacted with the

students in determining their knowledge.

INPUT
 According to the theorist input refers to energy, matter and information. All

system must receive varying type and amounts of information from the environment.

In this system the input was to maintain its homeostasis. In this study the information

related CPR.

Elements which has,

x Closed ended questionnaire

x STP on CPR

THROUGHOUT

According to Kenny through put refers to the process by which the system process

inputs and release on output.

x In the present study the throughput considering out processing of inputs which

are pre and post test regarding the knowledge of CPR

OUTPUT AND FEEDBACK

According to Kenny feedback refers to output which is returned to the system

that allows it to monitor itself overtime in an attempt to more clearly to a steady state

known as equilibrium or homeostasis. Feedback may be +ve,-ve or neutral.

In this study the output is the post test knowledge score of students which are

divided into 5 groups such as very poor, poor, average, good and excellent.

Feedback is difference in mean percentage of pre and post test knowledge

score of student regarding CPR.

CHAPTER-II

REVIEW OF LITERATURE

CHAPTER- II

REVIEW OF LITERATURE
 Review of literature is a key step in research process. Nursing research may be

considered a continuous process in which knowledge gained from earlier studies is an

integral part of research in general. One of the most satisfying aspects of the literature

review is the contribution it makes to the new knowledge, insight and general

scholarship of the researchers. ‘A literature review is a complication of resources that

provide the ground work for future study.’

Review of literature is defined as a broad, comprehensive, in depth, systematic

and critical review of scholarly publications, unpublished scholarly print materials,

audio visual materials and personal communications.

The literature reviewed has been presented under the following headings:

A) Studies related to incidence and prevalence of cardiac arrest

B) Studies related to knowledge on CPR

C) Studies related to structured teaching program in CPR

A) STUDIES RELATED TO INCIDENCE AND PREVALENCE OF CARDIAC

ARREST

TVS Murthy and Bhavna Hooda, September 13 2009. The study conducted

related to cardio cerebral resuscitation is better than CPR. The guidelines for CPR

have been in place for decades; but despite their international scope and periodic

update there has been improvement in survival rates in out-of-hospital cardiac arrests

for patients who did not received early defibrillation. Instituting the new cardio

cerebral resuscitation protocol for managing pre-hospital cardiac arrest improved

survival of adult patients with witnessed cardiac arrest and an initially shock able

rhythm.
 Dr. H. Shankar (2008). The study conducted related to cardiac arrest and

CPR. The study shows that the sudden cardiac arrest in the hospital setup can be

anticipated at any time. Are be prepared to handle such an event around us? We are

experienced in our emergency department during the month April 2008. The patients

were successfully resuscitated and went home after few days walking their own

without any neurological deficits.

Benjamin S. Abella et al(2005) conducted a study on quality of

cardiopulmonary resuscitation during in hospital cardiac arrest. The main

objective of this study is to measure multiple parameters of in-hospital CPR quality

and to determine compliance with published American Heart Association and

international guidelines. The sample consisted of 67 patients who were experienced

in-hospital cardiac arrest at the University Of Chicago Hospitals, Chicago. The result

of this study indicates that the importance of high-quality CPR suggests the need for

rescuer feedback and monitoring of CPR quality during resuscitation effort.

The United States government (2003) publishes very detailed figures on the

incidence and prevalence of heart disease. Incidence is the number of events or new

diagnoses per year. Prevalence is the number of person with the disease at any given

time. Thus, there were 13.2 million Americans with heart disease in 2003 (this is

prevalence - number at any given time) and there were 1.2 million Americans with a

diagnosis of new or recurrent coronary heart disease in 2003 (this is the annual

incidence - number of new or recurrent cases in a year). The American Heart

Association distills this information into an annual summary called Heart Disease and

Stroke Statistics. 34% of Americans have cardiovascular disease - defined as

coronary heart disease (16 million), stroke (5.8 million), high blood pressure 73

million), heart failure (5.3 million). The annual incidence of a new or recurrent
coronary attack is 1.2 million (770,000 will have a new coronary attack and 430,000

will have a recurrent attack). The lifetime risk of developing coronary heart disease

assume you make it to age 40 is 49% for men and 32% for women. Every minute in

the United States someone dies from coronary heart disease. The average number of

years of life lost due to sudden cardiac arrest is 15 years 50% of men and 64% of

women who die suddenly from coronary heart disease have no previous symptoms of

the disease.

Eisenberg MS, Becker LJ, et al. 2003. Getting a handle on the number of

sudden cardiac arrests is a bit trickier. If one looks only at death certificates the figure

is 456,000 per year. I think a more realistic figure is 155,000, the number of sudden

deaths in which emergency medical services are called and attempt to resuscitate the

individual. This lower figure gives a more realistic picture of the number of persons

who are potentially "resuscitatable" from cardiac arrest since it does not include

persons who are found cold and dead (even though their deaths may be coded as acute

coronary heart disease). To put this in perspective, the EMS system in King County in

2000 responded to 1428 calls for cardiac arrest but attempted resuscitation on 808.

The other 620 were considered dead on arrival. In addition the vital statistics office in

King County recorded 1029 out of hospital deaths from heart disease for which the

EMS system was not called. There were also 1249 deaths in hospital without an out of

hospital cardiac arrest. (The total deaths from heart disease was 3705 during the year)

EMS personnel responded to 57% (1428/2457) of all out of hospital death events but

only 39% (1428/3705) of all deaths.

Singh L Ranbir and Team in Rims Hospital, Manipur.(2002) A study of

32 children with near drowning, admitted in RIMS Hospital, Manipur during January

1997 to December 2000 revealed that near drowning accounted for 0.29% of total
pediatric hospital admissions. The prominent characteristics of pediatric near

drowning were male sex 65.6%, age below 3 years 75%, summer season 43. 7%,

residential pond 71.9%, morning hours 56.3%. 26 (81.2%) cases had varying degrees

of pulmonary aspiration. Neurologically, 5 (15.6%) cases were awake 21 (65.6%)

cases had blunted levels of consciousness and 6 (18.8%) cases were comatose at the

time of arrival. Following cardiopulmonary resuscitation (CPR) at the scene of rescue

and appropriate respiratory and cardiovascular support on arrival, 31 (96.9%) cases

had intact survival and only 1 (3.1%) had mild neurological sequelae at the time of

discharge. There was no mortality.

Vanderschmidt H, Burnap TK, Jhwaites J.K 1975 Sep; 13(9) A study

conducted by evaluation of a cardio pulmonary resuscitation use for secondary

schools. The objective of this study was to test the feasibility of teaching secondary

school students to perform cardio pulmonary resuscitation fifty five percent of the

practice group in the initial test and 31 percent of the retention studies were able to

perform the skills. The study suggests that it is possible to train secondary school

students to perform the ABC, of CPR if they have an opportunity to practice their

skill. The study also suggests that the teacher training is an important factor.

B) STUDIES RELATED TO KNOWLEDGE ON CPR:

Resuscitation is a technique used by professional health care staff, as well as

members of the public. It is essential for all health care professionals to be able to

perform basic life support, and training for staff who is commonly involved with

resuscitation attempts must take place on a regular basis. If a cardiac arrest occurs in

the community, the patient must be moved onto a hard surface and placed on his or
her back. Quickly make the environment appropriate for performing life-saving

procedures. This could mean moving chairs or tables.

Tom Sirmons, August 2, 2011, A wealth of recent research reaches the same

conclusion: those who suffer cardiac arrest are far more likely to survive long-term if

a bystander immediately begins proper CPR. That’s especially true when emergency

medical personnel are unable reach the scene within eight minutes. BUT –

considering that brain damage from lack of blood flow begins as soon as four

minutes after heart failure, the need for CPR administration is vital, in the truest sense

of that word, no matter how good you think EMT response-time is in your area. And

there’s more: If you learned CPR five or more years ago, you are almost certain to

apply it incorrectly. Granted, survival rates are higher even among those who receive

outdated CPR, but the American Heart Association now stresses that maintaining

blood flow to the organs is more important than trying to restore breathing via mouth-

to-mouth resuscitation. In fact, a study published in The Lancet several months ago

found survival rates among heart attack victims are substantially higher when only

proper chest-compression is administered. The old model of alternating compressions

with breaths into the victim’s lungs is less effective. Also, note the italicized word

above – proper .Chest compressions must be performed with the right combination of

repetition and depth to achieve optimal results. In a word, that means training. It’s not

a matter of instinct or common sense to know how hard and how often to press down

on a cardiac victim’s sternum. The fact is that it’s harder and more frequent than an

untrained person is likely to realize. Here’s a hint about compressions: more than one

per second! While a 911 dispatcher can you give you basic information over the

phone, nothing takes the place of training, which is so readily accessible in almost

every community!
 Karan Prakash Singh 2 May 2011 and team The study to assess the

knowledge and personal experience with CPR among dentist in Udaipur India. This

study shows that 75.9% of dentist had received information about basic CPR but only

66.0% had the current concept of performing it and only 12% had received practical

training in basic CPR. 1 in 10 dentists had seen patients suffering from

cardiopulmonary arrest in their practice, but none –of them mentioned any fatality,

because CPA. The level of knowledge was significantly higher among faculty dental

practitioner compared with local dental practitioner. In addition a positive linear

correlation was found between educational level and knowledge level.

Malekk J, Kurzova A, Berankova M and Knor J, 2007 September 20, The

study conducted regarding the knowledge level of CPR in secondary school students

of non-medical specialization in the Czech Republic. The aim was constant attention

given to the education in CPR mainly among adolescents. Results demonstrated that

in spite of the effort to increase the level of knowledge in CPR in Laymen, the actual

level of knowledge is low and more frequent repetition of courses should be

considered. In the future, we shall evaluate the effectiveness of new educational film.

Losert H et al (2006) conducted a observational study on quality of

cardiopulmonary resuscitation among 95 highly trained staff nurses in an emergency

department of the tertiary care hospital, Austria. The findings of this study was highly

trained professionals in an emergency department can achieve appropriate chest

compression rates during CPR with a low hands-off ratio. Increased attention must be

paid in all situations to the avoidance of hyperventilation.

Thoren Ann-Britt et al (2005) has conducted a study on Possibilities for, and

obstacles to, CPR training among 401cardiac care patients and 311co-habitants. The aim

of the study was to investigate the level of cardiopulmonary resuscitation (CPR) training

among cardiac patients and their co-habitants. According to the answers given by the
patients, 46% of the patients and 33% of the co-habitants had attended a CPR course at

some time. Younger persons were more often willing to undergo training than older

persons. Of those patients who had previously attended a course or who were willing to

undergo training, 72% were prepared to do so together with their co-habitant. The main

outcome was the two-thirds of the patients did not believe that their co-habitant had taken

part in CPR training. More than half of these would like their co-habitant to attend such a

course. Seventy-two percent were willing to participate in CPR instruction together with

their co-habitant. Major obstacles to CPR training were doubts concerning the co-

habitant's willingness or physical ability and their own medical status.

NURSING TIMES, October, 2003, In the hospital environment, remove the

headboard from the bed and adjust the mattress, so it is suitable for performing chest

compressions, and move the cardiac arrest trolley next to the patient's bed. These

procedures should take a very short time when you work effectively as a team. The

advanced life support stage continues until resuscitation efforts are terminated or the

patient is transferred to intensive care. Good basic life support and defibrillation are

the top priority. There is no robust data to show that drugs used in cardiac

resuscitation alter long-term outcomes (Resuscitation Council UK, 2002).Performing

basic life support.

BMY Cheung (2003) Conducted a study regarding knowledge of CPR among

the public by telephone questionnaire survey in Hongkong . Telephone interview

method was used for this study. Study was conducted among 357 people;

approximately 12% had received CPR training. CPR knowledge in Hongkong was

poor, even among the previously trained and especially with regard to circulatory

maintenance. The most common reason for not taking CPR training was lack of time.

Intensified educational efforts and exploration of new approaches to improve this first

stage in the chain of survival are warranted.

 Sanders AB, Kern KB, and Berg RA (2002) A study conducted by on

survival and neurological outcome after cardio pulmonary resuscitation with four

different chest compressions ventilation ratios. The objective was to determine 24

hours survival and neurological outcome. The result shows that there was no

statistically significant difference in 24 hours survival among 4 groups. There were

significant differences in 24 hour Neurological function, as elevated by using the

swine cerebral performance category scale.

Celenza T, Gennat, Brien D, 2002 November, The study conducted on

community competence in CPR. The aim of this study was to determine community

application of CPR skills in an emergency and to assess the value of training

programmes in raising community competence. Telephone survey was conducted, the

population was chosen randomly. Sub sample performed a practical demonstration of

CPR skills using manikin as the victim, performance was assessed by two observers

using pre-determined criteria.

Lan H Kerridge et al (1998) conducted a study on decision making in CPR:

attitudes of hospital patients and healthcare professional. The purpose of this study

was to examine the opinions of patients and healthcare professionals regarding the

process of making decisions about cardiopulmonary resuscitation. The samples

consist of 511 health care professionals and 152 patients at the John Hunter Hospital,

Newcastle, New South Wales. 80% of patients and 99% of healthcare professionals

thought patients' views should be taken into account when making CPR decisions.

More patients than healthcare professionals indicated that doctors should be the main

decision makers. Most patients and healthcare professionals wanted their views in

their medical records. Results indicated that the 80% patients, 99% of health care

professionals want to be involved in CPR decision making and many want some form

of advance directives.
C) STUDIES RELATED TO STRUCTURED TEACHING PROGRAM IN CPR

Resuscitation Council (UK) Both ventilation and compressions are important

for victims of cardiac arrest when the oxygen stores become depleted: about 2 - 4 min

after collapse from ventricular fibrillation (VF), and immediately after collapse for

victims of asphyxial arrest. Previous guidelines tried to take into account the

difference in causation, and recommended that victims of identifiable asphyxia

(drowning; trauma; intoxication) and children should receive 1 min of CPR before the

lone rescuer left the victim to get help. But most cases of sudden cardiac arrest out of

hospital occur in adults and are of cardiac origin due to VF (even though many of

these will have changed to a non-shockable rhythm by the time of the first rhythm

analysis). These additional recommendations, therefore, added to the complexity of

the guidelines whilst applying to only a minority of victims. Many children do not

receive resuscitation because potential rescuers fear causingharm. This fear is

unfounded; it is far better to use the adult BLS sequence for resuscitation of a child

than to do nothing. For ease of teaching and retention, laypeople.

White L, Rogers J, Bloomingdale M, Fahrenbruch C, Culley L, Subido C,

Eisenberg M, Rea T, 2010 Jan 5 ..A total of 100 students underwent the three hour

training programme, ranging in age from 14 -19 years. Of these, 44 (44%) were

female and 56 (56%) were males. 70% of students performed all CPR steps and 75%

all AED steps. Students scored better in chest compression (CC) performance,

particularly the parameters, achieving adequate release of CC (85%), correct CC

depth (83%) and correct hand positioning (66%). 50% of students achieved the

correct CC rate according to the set standard (90-110/min). Students tended to

perform CC at a faster rate as 90% of students were achieving a rate between 90-

120/min. No student was performing CC under 90/min.50% of students achieved, on

average, the correct ventilation volume according to the accepted standard (500 –

800mls). While 84% of students were delivering ventilations with an open airway,
40% of students were delivering ventilations in excess of the standard. This study

shows that school children have the capacity to acquire CPR/AED skills from a three

hour programme in BLS. Consistent with previous studies, students also had greater

confidence in their ability to perform CPR/AED skills and a greater willingness to

intervene in an emergency situation after training (Vaillancourt, 2008, Donohoe et al.

2006).The results of this study show that students performed quality CC at an

acceptable standard. They had greater difficulty performing adequate ventilations,

with problems inflating in excess of the standard. This supports existing evidence that

delivering ventilations is a difficult skill for lay people and argues that it would be

reasonable to simplify CPR procedures and concentrate lay rescuers’ energy on CC

(Sanders and Ewy, 2005, Kellum, 2007). Chest compression-only CPR has also the

added advantage of eliminating mouth-to-mouth contact and associated risk of

contracting infection, which was identified as the greatest barrier to performing CPR

in this study.

A study conducted by White L et.al (2010) on Dispatcher-assisted

cardiopulmonary resuscitation: risks for patients not in cardiac arrest reveals that the

frequency of serious injury related to dispatcher-assisted bystander CPR among non

arrest patients was low. When coupled with the established benefits of bystander CPR

among those with arrest, these results support an assertive program of dispatcher-

assisted CPR.

Shanta Chandrasekaran, Sathish Kumar, 2010, A cross-sectional study was

conducted by assessing the responses to 20 selected basic questions regarding Basic

Life Support, among students of nursing colleges in Tamilnadu, India to study the

awareness of Basic Life Support (BLS), in nursing colleges. After excluding the

incomplete response forms the data was analysed on 1,054 responders. The results

were analysed using an answer key prepared with the use of the Advanced Cardiac
Life Support manual. Out of 1,054 responders no one among them had complete

knowledge on BLS. Only 2 out of (0.19%) had secured 80 - 89% marks, 10 out of

(0.95%) had secured 70 - 79% marks, 40 of (4.08%) had secured 60 - 69% marks and

105 (9.96%) had secured 50 - 59% marks. A majority of them that is 894 (84.82%)

had secured less than 50% marks. Awareness of BLS among students in nursing

colleges is very poor and teaching is required.

Karthik Murugiah And Team In 2010 A study conducted about the

widespread knowledge of CPR is a critical to improving survival in sudden cardiac

death. YouTube and internet video site which is growing source health care

information for source, content and quality of information about CPR. Of 800 videos

screened 52 met inclusion criteria with mean duration of 233 and view count 37 per

day. 48 % videos were by individuals with unspecified credentials. Scene safety

assessment in 65% videos. Only 69% videos demonstrated the correct compression-

ventilation ratio while 63.5%, 34.6%, and 40.4% gave information on location rate

and depth of chest compression respectively. 19% videos incorrectly recommended

checking pulse. Videos judge the best source for CPR information were not the once

most viewed. Information on this platform is unregulated; hence content by trusted by

sources should be posted to provide accurate and easily accessible information about

CPR. You Tube may have a potential role in video assisted learning of CPR and as a

source of information for CPR in emergency.

Anil Kumar Parashar, February 2010 A study was conducted regarding the

effectiveness of planned teaching programme (PTP) on knowledge and practice of

Basic Life Support among high school students in Bangalore. The research design

used for the study was quasi-experimental design. The sample consisted of 40 rural

high school students. The study was conducted in rural high school of Mangalore and

the subjects were selected through simple random sampling technique. The study
showed that majority (87.5%) of the students had inadequate knowledge and (100%)

had poor practice. The planned teaching programme facilitated them to update their

knowledge and practice related to Basic Life Support. Hence, the planned teaching

programme is an effective teaching strategy to improve knowledge and practice of

sample on BLS.

A study conducted by Settgast A et.al (2006) on an innovative approach to

teaching resuscitation skills reveals that residents benefit from additional teaching and

practice in actual performance of basic skills used during cardiac arrests. Furthermore,

our data demonstrate that comfort levels among house officers increase when they are

given the opportunity to practice these skills.

Hassan Zaheer [Jinnah Medical & Dental College (JMDC), Karach]

&Zeba Haque [Dow International Medical College (DIMC), Karachi](2002) was

done a cross sectional study was conducted by using responses to a questionnaire

regarding BLS by 61 students in Pakisthan. The results were analyzed with SPSS

version 11.101. Out of 61 students only 9 (14.7%) had taken a BLS (CPR) course

while 52 (85.3%) students had not attended any such course. Significantly more

number of students had the theoretical knowledge about BLS (76.07% vs. 49.18%,

p<0.00). Practical knowledge about BLS was scored as having no, some and complete

knowledge of the course. Of all the students, 57.3% had no knowledge, among those

34% had heard BLS from somewhere, 22.9% had some knowledge out of which 50%

had heard about it. Significantly less number of students had complete knowledge

about BLS (4% p<0.05). Among the students who had taken the course, 22% had

complete knowledge (p<0.05). Significantly less number of students knew about the

skills for BLS (21% p<0.0A significant number of students were aware of the general

idea of BLS which was assessed by the correct responses. A large number of students

knew about the abbreviation, purpose and importance of the maneuver (first, second
and last question) (p<0.001) (Table). Only [(T1)] 10.9% students replied incorrectly

(p<0.001).On the contrary, a big number of students responded incorrectly to the

questions on the skills involved in BLS (CPR). On an average only 18%, (p<0.001)

provided correct answers. Of all 36.66% students did not know about BLS and the

rest gave wrong answers.. It shows that about half of the students had heard about the

BLS course. However significantly higher student population insisted to have it

included in the undergraduate curriculum (68 out of 86, p<0.0015).

Catherine Madden(2002) The study used an across methods design and

included two phases. In Phase 1, 100 post-primary students from three schools

undertook the ‘Save a Life’ programme. Using pre and post-tests, a questionnaire

was given to students before and after training to evaluate their knowledge, attitudes,

willingness and anxieties towards performing CPR/AED. After the programme,

students’ CPR/AED psychomotor skills were assessed in a simulated cardiac arrest

scenario using a Resusci-Anne manikin and the Laerdal PC skills reporting system.

In Phase 2, focus group interviews were conducted with nursing students to explore

their experiences of the service learning experience. Informed consent was obtained

from both the school students and the nursing students and ethical approval was

secured.

Pauline (1998 )conducted a study to assess the nurses level of knowledge

regarding CPR found that only 2.6% nurses had adequate knowledge, 44.7% had

moderately adequate knowledge and 52.7% had inadequate knowledge. She

concludes that resuscitation knowledge should be refreshed and updated regularly.

Nahigian E, Tutuska AM, Wieser MA, 1996 June, The study conducted by

on making a CPR practice decision. This investigation explored whether there are

significant differences between CPR. The purpose of the study was to validate a

decision to discontinue reliance on manikin generated strips to document satisfactory

performance of CPR manikin practice skills. One rescuer and two rescuer CPR strips

were blindly collected from all CPR course participants during a six month period.

The result indicated no significant difference between the two methods of evaluation.
CHAPTER-III

RESEARCH
METHODOLOGY

CHAPTER-III

RESEARCH METHODOLOGY
 The methodology of research indicates the general pattern of organizing the

procedure for gathering valid and valuable data for the purpose of investigation. The

methodology of this study includes the research approach, research design, setting of

the study, population sample and sampling technique, development of tool, data

collection procedure and plan for data analysis.

RESEARCH DESIGN AND APPROACH:

Research design refers to the researchers overall plan for obtaining answer to

the research questions and it spells out the strategies that the research depots to

develop information that is adequate, accurate objective and interpretable. (Polit and

Hungler, 2002)

The design selected for the present study was quasi experimental design and

approach in which one group pre and post design without control group.

RESEARCH DESIGN

O1---------x----------O2

O2-O1=E

The symbols used are:

O1 - knowledge of CPR before implementing structured teaching programme.

X - Structured teaching programme regarding CPR

O2 - knowledge of CPR after implementing structured teaching programme

E - Effectiveness of structured teaching programme

SETTING OF THE STUDY:

 The study was conducted in Anbu Arts and Science College, Komarapalayam,

Namakkal.It is nearly 3km away from the komarapalayam bus stand.

POPULATION:

Population refers to the aggregate or totally of those conforming to a set of

specification. (polit and Beck,2006)

The population of this study was degree students.

SAMPLING AND SAMPLING TECHNIQUE:

a)Sample

Sampling refers to the process of selecting the portion of population to

represent the entire population. (Polit and Hungler, 2002)

The students studying in Anbu arts and science college,Komarapalayam.

b) Sample size

Sample is subset of the population selected for a particular study and the

number of sample are the subjects.(Burns N,2001)

The sample size was 50 students in a selected college, komarapalayam.

c) Sampling technique

Sampling technique refers to the process of selecting a portion of the

population to represent the entire population.(Polit and Beck,2007)

Purposive sampling technique is a judgment sampling that involves the

conscious selection from the research of certain subjects of element to include the

study.(Denise F Polit,2004)

Purposive sampling technique was used to select the subjects for the study.
INCLUSION CRITERIA:

This study was conducted for the student who were,

• degree students

• studying in Anbu Arts and science college

• age group(19-22)

• able to read English.

EXCLUSION CRITERIA:

• Not willing to participate

• Not able to read English

• Not available during the time of data collections

DEVELOPMENT OF TOOLS:

The following tools was used for the present study-

1. Structured teaching programme regarding CPR among degree students.

2. Questionnaire to assess the knowledge regarding CPR among degree students.

THE STEPS USED FOR PREPARING TOOL:

1. Review of related literature:

The literature (nursing book, medical and surgical book, journals, reports and

articles) was referred to prepare the tools and guide also consulted.

2. Preparation of tool:
A) Lesson plan

It consists of preface, physiology of heart, indications of CPR, importance of

CPR, steps in CPR and complications of CPR.

B) Questionnaire-

It was prepared to assess the knowledge of degree students regarding CPR.

3. Consultation with guide and research committee

The blue prints were given to the experts in research committee .The research

guide and committee members were consulted before finalizing the tool.

4. Preparation of the final draft:

Final draft of the tool was prepared after consulting with the expert and

research committee.

DESCRIPTION OF THE TOOL:

Construction of Questionnaire

The questionnaire consists of 2 parts.

Part A:

It consists of demographic characteristics such as age, sex, Father’s education,

Mother’s education, Type of family, Residential area, Religion, previous knowledge

of CPR.

Part B:

It consists of knowledge items regarding CPR.This section consists of 45

items. Each item has four options with one most correct answer. For each item, the
correct answer carriers the score of ‘one’ and wrong answer carries the score of

‘Zero’. There for 45 items there was 45 maximum obtainable score.

Scoring Procedure

To assess the level of knowledge of students, the score was grouped into item

like very poor, poor, average, good and very good based on knowledge scores.

Scoring procedure

Table: Scoring the level of knowledge

Level of knowledge Percentage of scores Actual scores

Very poor <20% 0-9

Poor 21% to 40% 10-18

Average 41% to 60% 19-27

Good 61% to 80% 28-36

Very Good 81% to 100% 37-45

4. Test of Validity and Reliability

a) Validity

Validity is the degree to which on instrument measure what it is supposed to

measure.(Polit and Beck,2007)

Content validity of the questionnaire and lesson plan was established and sent

to experts from various fields such as medical and surgical nursing (n-3), doctorate in

medicine (n-1), biostatician (n-1).Their opinion and suggestions was considered to

modify the tools.

b) Reliability
 Reliability of the tools was tested by implementing the tool and structured

teaching programme on 5 students admitted in other departments in anbu arts and

Science College. Test retest method where karl’s pearsons correlation formula was

used to find out the reliability of tool. The r value was r = 0.9.

Ethical Consideration

Prior to the data collection written permission was obtained from the Principal,

Anbu Arts and Science College, komarapalayam.

Data Collection Procedure:

Period of data collection

During this period, the investigator collects both pre test, teaching with

structured teaching programme and then posttest.

Stages of data collection

The data was collected in following three steps:

a) Pre-test

Pretest was conducted among degree students who were admitted in Anbu arts

and Science College, by giving questionnaire to assess the knowledge on CPR, before

implementation of STP.

b) Implementation of STP

Immediately after pretest, STP was given to the same students regarding CPR.

c) Posttest
 Evaluation was done by conducting posttest after 7 days of implementation of

STP. Post test was conducted by using the questionnaire used for the pretest.

PLAN FOR DATA ANALYSIS:

The collected data was analyzed by using descriptive statistics such as

percentage, mean, & Standard Deviation. The collected data was presented in the

form of tables and figures.

Fig 3.1 .SCHEMATIC PRESENTATION OF RESEARCH DESIGN

TARGET POPULATION

DEGREE STUDENTS(19-22Yrs)

ACCESSIBLE POPULATION

Students studying in Anbu Arts and Science College

DEMOGRAPHIC VARIABLE SAMPLING

SAMPLE AND TECHNIQUE
Age, sex, Education, , Religion, SAMPLE SIZE
Duration of stay in old age home, Type Purposive Sampling
50 degree students Technique
of family, Monthly Income, Diet pattern,
No of children, Marital status, residence.
 DATA COLLECTION

Post-test Intervention
Pre-Test without Structured teaching
Intervention programme regarding
CPR

Test score

Analysis and Interpretation

Findings

CHAPTER-IV
 DATA ANALYSIS AND
INTERPRETATION

CHAPTER-IV
The term “analyses” refers to the computation of certain measures along with

searching for patterns of relationship that exists among data groups. (Kothari .C.R.,

2004).

During analyses, the emphasis is on identifying themes and patterns in the

data. Interpretation may focus on the usefulness of the findings for the clinical

practice or may toward theorizing (Burns Nancy and Grove .S.K., 2007).

This chapter deals with analyses and interpretation of the information

collected from 50 degree students who were studied in Anbu Arts and Science

College, Komarapalayam.The present study was designed to assess the effectiveness

of structured teaching programme on Cardio Pulmonary Resuscitation among degree

students. Collected data was tabulated, analyzed and interpreted using descriptive and

inferential statistics.

OBJECTIVES OF THE STUDY:

4. To assess the knowledge level regarding cardio pulmonary resuscitation

among degree students in a selected college.

5. To evaluate the effectiveness of structured teaching programme on knowledge

regarding cardio pulmonary resuscitation among degree students in a selected college.

6. To find out the association between knowledge regarding cardio pulmonary

resuscitation among degree students with their selected socio demographic variables.

ORGANIZATION OF FINDINGS:

Section I: - Descriptive analysis of demographic variables.

Section II: - Assessment of knowledge of degree students regarding CPR prior to

implementation of STP.

Section III: - Comparison of pretest and posttest knowledge scores of the degree

students regarding CPR.

Area wise comparison of mean, standard deviation and mean percentage of pre and

post test knowledge scores of degree students regarding CPR.

Section IV: - Association between the knowledge and their selected demographic

variables

HYPOTHESIS:

H1: There will be significant difference between pretest and post test

knowledge score regarding cardio pulmonary resuscitation.

H2: There will be significant association between the knowledge with selected

demographic variables of the degree students such as age, sex, religion, previous

information regarding cardio pulmonary resuscitation

SECTION I: - DESCRIPTIVE ANALYSIS OF DEMOGRAPHIC VARIABLES.

This section deals with the percentage distributions of the selected

demographic variables of the degree students.

TABLE NO 4. 1:-FREQUENCY AND PERCENTAGE DISTRIBUTION OF
STUDENTS ACCORDING TO THE DEMOGRAPHIC VARIABLES:

Demographic Variables Frequency Percentage (%)

18 05 10
Age 19 27 54
20 11 22
21 07 14
Sex Male 11 22
Female 39 78
Father’s Education Educated 21 42
Illiterate 29 58
Mother’s Education Educated 19 38
Illiterate 31 62
Residential Area Urban 21 42
Rural 29 58
Type of Family Joint 11 22
Nuclear 39 78
Hindu 47 94
Religion Muslim 01 02
Christian 02 04
Previous Yes 28 56
Knowledge No 22 44

Media 24 86
Source of Books 01 3.5
information Relatives 02 07
Friends 01 3.5
Maths with 17 34
Biology
Group studied in Computer science 17 34
XII Pure science 05 10
Vocational 08 16
 Others 03 06

Regarding age, 10%(05) of respondents are in the age group of 18 years,

54%(27) of respondents are in the age group of 19 years, 22% (11) of respondents are

in the age group of 20 years and 14%(07) of respondents are in the age group of 21

years.

According to the sex, 22 %( 11) of respondents are male students and 78 %(

39) of respondents are female students.

According to the father’s educational status of degree students, 42 %( 21) are

educated and 58 %( 29) are Illiterate.

According to the mother’s educational status, 38 %( 19) are educated and 62

%( 31) are Illiterate.

According to the residential area of degree students, 42 %( 21) of respondents

are from urban area and 58 %( 29) of respondents are from rural area.

According to the type of family, 22 %( 11) of students belong to joint family,

78 %( 39) of students belong to nuclear family.

According to their religion, 94% (47) of students are Hindu, 2 % (1) of student

are Muslim, and 4% (2) of students are Christian.

According to their previous knowledge, 56 %( 28) of students are having

previous knowledge about CPR and 44 %( 22) of students are not having knowledge

about CPR.

According to the source of information, 86 %( 24) of students got through

media, 3.5 %( 01) of students through books, 7 %( 02) of students through relatives,

and 3.5 %( 01) of students got through friends.

 Regarding higher secondary course, 34%(17) of students from Maths with

Biology,34% (17)of students from Computer Science,10% (05) of students from Pure

Science,16%(08) of students from Vocational and 6%(03) of students from other

groups.
Fig. 4.1: Bar diagram showing age distribution of degree students
 SEX DISTRIBUTION

male
22%

female
78%

Fig. 4.2: Pie diagram showing sex distribution of degree students

 FATHER' S EDUCATION STATUS

42%

Educated
Illiterate
58%

Fig. 4.3: Pie diagram showing father’s educational status of degree students
 MOTHER'S EDUCATION STATUS

38%

Educated
Illiterate

62%

Fig. 4.4: Pie diagram showing mother’s educational status of degree students
 RESIDENTIAL AREA

42%

58% Urban
Rural

Fig.4.5: Pie diagram showing residential area distribution of degree students

 TYPE OF FAMILY

22%

Joint
Nuclear

78%

Fig.4.6: Pie diagram showing the distribution of students based on type of family
 RELIGION
94%
100
90
80
70
% of Students

60
50
40
30
20
2% 4%
10
0
Hindu Muslim Christian

Fig. 4.7: Cone diagram showing distribution of degree students according to

their religion
 PREVIOUS KNOWLEDGE

44%
Yes
No
56%

Fig.4.8: Pie diagram showing distribution of degree students based on their

previous knowledge
 SOURCE OF INFORMATION
86%
90

80

70
% of Students 60
50
40
30
20
10 3.5% 7%
0 3.5%

Media
Books
Relatives
Friends

Fig.4.9: Bar diagram showing distribution of students based on their knowledge

source of information
 GROUP STUDIED IN XII

34% 34%
35
% 0f Students 30
25
20
15 16%
10 10%
5
0 6%

Maths with
Computer
Biology Pure
Science Vocational
Science Others

Group studied in XII

Fig. 4.10: Pyramid diagram showing distribution of students based on their

group studied in XII

SECTION II:-

KNOWLEDGE OF DEGREE STUDENTS REGARDING CPR PRIOR TO

IMPLEMENTATION OF STP.

TABLE NO 4.2: Area wise Distribution of mean, Standard deviation and mean
percentage of pretest knowledge scores of the CPR among degree students.
 Max Scores
Areas Obtainable
Scores Mean SD Mean
percentage
Anatomy and
physiology of 11 6.4 1.35 58.18
heart
Cardiac Arrest 05 2.6 1.35 52

Cardiopulmonary 29 9.6 1.2 33.1

Resuscitation
Overall 45 18.6 4.14 41.33

Area wise distribution of mean , SD, and mean percentage of pretest

knowledge scores of the degree students regarding CPR shows that among three
areas, the highest mean score (6.4+ 1.35) which is 58.18% was obtained for the area “
Anatomy and Physiology of heart” ,more or less similar mean score (2.6+1.35) which
is 52% was obtained for the area “ Cardiac arrest” .The lowest mean score (9.6+ 1.2)
which is 33.1% was obtained for the area “ Cardiopulmonary Resuscitation”
revealing poor knowledge. However, for all the other areas the mean percentage was
41.33.

TABLE NO 4.3: LEVEL OF KNOWLEDGE OF STUDENTS ON CPR

LEVEL OF MIN-MAX FREQUENCY PERCENTAGE %

KNOWLEDGE OBTAINABLE PRETEST POSTTEST PRETEST POSTTEST
SCORE
Very Poor 0-9 01 -- O2 --
 Poor 10-18 26 -- 52 --
Average 19-27 22 -- 44 --
Good 28-36 01 29 02 58
Very Good 37-45 -- 21 -- 42

Table 3 shows pretest overall level of knowledge for degree students.52% of

students had poor knowledge and 44% of degree students had average knowledge.

Posttest overall knowledge level for degree students.58% of students had good

knowledge and 42% of degree students had very good knowledge.

 LEVEL OF KNOWLEDGE
58%
60
52%

Percentage of Students 50 44%

42%

40

30
Pretest

20 Posttest

10
2% 2%
0% 0% 0% 0%
0
0-9 10- 18 19-27 27-35 36-45
Marks

Fig.4.11:Bar diagram showing distribution of marks among degree students in

pre and post test

SECTION III: - COMPARISON OF PRETEST AND POSTTEST

KNOWLEDGE
SCORES OF THE DEGREE STUDENTS REGARDING CPR

TABLE NO: 4. 4 Area wise comparison of mean, standard deviation and mean

percentage of pre and post test knowledge scores of degree students regarding

CPR.

Maximum Pretest Scores Posttest Scores Difference

Area Scores Mean SD Mean Mean SD Mean in Mean

% % %

Anatomy and 11 6.4 1.35 58.18 9.84 1.0 89.45 31.27

Physiology of 36
heart
Cardiac Arrest 05 2.6 1.2 52 4.08 1.0 81.6 29.6
27
Cardio 29 9.6 3.13 33.10 21.88 3.3 75.4 42.3
pulmonary 35
Resuscitation
Overall 45 18.6 4.14 41.33 35.8 3.9 79.5 38.17

Comparison of overall mean, SD and mean percentage of pre and post test

knowledge scores shows that over all pre test mean score was 18.6+_4.14 which is

41.33%whereas in post test the mean score was 35.8+- 3.5 which is 79.5% revealing

the difference of 38.17% shows the effectiveness of STP.

TABLE NO 4. 5:- Comparison between difference of pre and posttest knowledge

of degree students regarding Cardiopulmonary Resuscitation

Sl.No. Area ‘t’ value Level of

significance
 1 Anatomy and 14.95 Highly Significant
Physiology of heart
2 Cardiac Arrest 6.6 Highly Significant

3 Cardiopulmonary 20.66 Highly Significant

Resuscitation

P=1.982, P<0.05=Significant, P>0.05=not significant

Paired ‘t’test was calculated to assess the pre and post-test knowledge scores

of degree stu

dents regarding Cardiopulmonary Resuscitation. The finding shows highly significant

difference for all the areas. Thus, it can be interpreted that the difference in mean

score values related to the above mentioned areas were true difference and not by

chance. Hence, the null hypothesis is rejected and research hypothesis accepted

(P>0.05).It shows that the STP was effective for all the areas.

SECTION IV: TABLE NO 4.6: ASSOCIATION BETWEEN THE

SELECTED DEMOGRAPHIC VARIABLES WITH THE LEVELS OF
KNOWLEDGE AMONG DEGREE STUDENTS.

DEMOGRAPHIC LEVEL OF KNOWLEDGE CHI SQUARE

VARIABLES Very Poor Average Good VALUE
poor
18 0 1 4 0 ૏2=7.25
Age 19 1 15 10 1 Df=9(11.07)
20 0 6 5 0 p>0.05(NS)
21 0 4 3 0
Sex Male 0 7 4 0 ૏2=1.1788
Df=3(7.815)
Female 1 19 18 1
p>0.05(NS)
Father’s Educated 0 11 9 1 ૏2=0.091
Education Df=3(7.815)
Illiterate 1 15 13 0 p>0.05(NS)
Mother’s Educated 0 13 5 1 ૏2=2.82
Education Df=3(7.815)
Illiterate 1 13 17 0
p>0.05(NS)
Type of Urban 0 11 9 1 ૏2=0.09
Residential Df=3(7.815)
area Rural 1 15 13 0 p>0.05(NS)
Type of Joint 0 5 6 0 ૏2=1.039
Family Df=3(7.815)
Nuclear 1 21 16 1 p>0.05(NS)
Hindu 1 23 22 1 ૏2=34.47
Religion Muslim 0 1 0 0 Df=6(12.592)
Christian 0 2 0 0 p>0.05(NS)
Previous Yes 1 15 12 0 ૏2=0.035
Knowledge No 0 11 10 1 Df=3(7.815)
p>0.05(NS)
Media 0 12 12 0 ૏2=15.56
Source of Books 0 1 0 0 Df=6(12.592)
Information Relatives 1 1 0 0 P<0.05S
Friends 0 1 0 0
Maths with 0 6 11 0
Biology
Computer 0 10 6 1 ૏2=13.809
Group science Df=9(16.919)
studied in Pure Science 0 3 2 0 p>0.05(NS)
XII Vocational 1 5 2 0
Others 0 2 1 0

Chi square was calculated to find out the association between the knowledge

scores and demographic variables of the degree students. Significant association was

found between knowledge scores of degree students regarding Cardiopulmonary

Resuscitation with their demographic variables such as Source of information

(P<0.05). No significant association was found between knowledge scores of degree

students regarding Cardiopulmonary Resuscitation with their demographic variables

such as age,sex,father’s education, mother’s education, residential area, type of

family, previous knowledge, group studied in XII(P>0.05).

CHAPTER-V
 DISCUSSION AND
SUMMARY
CHAPTER-V

DISCUSSION AND SUMMARY

The aim of the present study was to assess the effectiveness of structured

teaching programme on Cardiopulmonary Resuscitation among degree students in a

selected college at Komarapalayam. The study was conducted by using quasi

experimental design. Sample size was 50 degree students selected by purposive

sampling technique.
 The effectiveness of structured teaching programme was evaluated by

questionnaire.

The responses were analyzed through descriptive statistics (mean, frequency,

percentage and standard deviation) and inferential statistics (paired ‘t’ test.)

DISCUSSION ON THE FINDINGS BASED ON THE OBJECTIVES OF THE

STUDY:

Objective-1

To assess the knowledge level regarding cardio pulmonary resuscitation

among degree students in a selected college.

Finding-1

The study findings revealed that (01)02% of students had Very poor

knowledge, (26)52% of students had poor knowledge, (22)44% of students had

average knowledge and the remaining (01)02% had good knowledge.

Discussion-1

The above findings were supported by the study conducted by Hassan Zaheer

studied the knowledge of CPR in 60 Students. They demonstrated about the CPR

using Manikins. After 7 days the knowledge level of the student was assessed and it

was improved.

Objective-2

To evaluate the effectiveness of structured teaching programme on knowledge

regarding cardio pulmonary resuscitation among degree students in a selected college.

Finding-2

The study findings revealed that comparison of overall mean, SD and mean

percentage of pre and post test knowledge scores shows that over all pre test mean

score was 18.6+_4.14 which is 41.33%whereas in post test the mean score was 35.8+-

3.5 which is 79.5% revealing the difference of 38.17% shows the effectiveness of

STP.
Discussion-2

The above findings were supported by the study conducted by Larsen P,

Pearson J, studied about the Cardiopulmonary Resuscitation. Here the sample

received the knowledge about CPR.So the researcher concluded that the STP gives

better result.

Objective-3

To find out the association between knowledge regarding cardio pulmonary

resuscitation among degree students with selected socio demographic variables.

Finding-3

The study findings revealed that association between the level of hemoglobin

and their selected demographic variables. It was interpreted that there was significant

association found between knowledge scores of degree students regarding

Cardiopulmonary Resuscitation with their demographic variables such as Source of

information (P<0.05). No significant association was found between knowledge

scores of degree students regarding Cardiopulmonary Resuscitation with their other

demographic variables such as age,sex,father’s education, mother’s education,

residential area, type of family, previous knowledge, group studied in XII(P>0.05).

The stated hypothesis was accepted.

Discussion-3

Sanders AB reported that Cardiopulmonary Resuscitation knowledge among

degree students was important. There was no significant association between the level

of knowledge and their selected demographic variables like age, sex, residential area,

type of family and education of parents.

SUMMARY

The present study was to “Assess the effectiveness of structured teaching

programme on knowledge regarding Cardio Pulmonary Resuscitation among

degree students in a selected college, Komarapalayam.”

IMPLICATION OF THE STUDY:

According to Tolsma (1995) the section of the research report that focuses on

nursing implication usually includes specific suggestions for nursing practice, nursing

education, nursing administration and nursing research.

Nursing Practice:

Nurses have the responsibility to improve the knowledge level of degree

students.

The present study will help the nurse to know the effectiveness of structured

teaching programme on knowledge regarding Cardiopulmonary Resuscitation. It will

help in creating the awareness among students about the Cardiopulmonary

Resuscitation.

Cardiopulmonary Resuscitation is one of the emergency management.

Nursing education:

Student has to update their knowledge regarding Cardiopulmonary

Resuscitation in emergency management.

The faculty member has to motivate the student to learn about the Cardiac

arrest and its immediate care.

Nursing administration:

The present study proposed to help the health administrator to create

awareness about the effectiveness of structured teaching programme on knowledge

regarding Cardiopulmonary Resuscitation among degree students to give a valuable

life.

Administrators have to educate the students through media regarding the

practice of CPR.

Nursing research:
 The study will be valuable reference for further research.

The findings of the study would help to expand the scientific body of

professional knowledge upon which further research can be conducted.

LIMITATION:

• The study was limited to degree students between the age group of (19-22 yrs)

• The study had only one group to prove the effectiveness of Structured teaching

programme

• The samples were selected by purposive sampling technique. .

RECOMMENDATIONS:

The study can be replicated in large sample size.

A similar study can be done in different settings and in different population.

A comparative study can be done to having two groups.

CONCLUSION:

The degree students had a good knowledge after structured teaching

programme about CPR. The structured teaching programme was effective to improve

the level of knowledge.

BIBLIOGRAPHY
 BIBLIOGRAPHY
BOOKS :

• B.T.Basavanthappa, “MEDICAL SURGICAL NURSING”,2nd

Edition(2009),,Jaypee publishers India,Pp no:956-958

•Brendan Docherty. Basic Life Support and AED. Clinical Manager Cardiology

and Critical Care. 2003, August: 56-59.

• Brunner & Suddarth’s,“TEXTBOOK OF MEDICAL

SURGICALNURSING”,10th Edition(2004),“ ,Lippincott Williams

&Wilkins,Pp No:250-251.

• Conover MB et al; “UNDERSTANDING ELECTROCARDIOGRAPHY,

ARRHYTHMIAS AND THE 12-LEAD ECG; 5th edition; pp no: 49.

• Davidson; “DAVIDSONS PRINCIPLE AND PRACTICE OF

MEDICINE”; 19th Edition;churchil livingstonePublishers; pp no: 403-405.

• George .JB, “NURSING THEORY, THE BASE OF PROFESSIONAL

NURSING PRACTICE”,4th Edition (1995), ,United States:Appleton &

Lange Pp No:14-19.

• Joyce.M.Black et al; “MEDICAL SURGICAL NURSING”;7th Edition;

Elsevier publication; pp no: 472-474.

• Lewis et.aI, “ MEDICAL AND SURGICAL NURSING”, 6th edition,

Philadelphia, Mosby publication 2004, Pp.879-884.

 • Patricia. A.Potter.et.al, “BASIC NURSING THEORY AND

PRACTICE”,8th(1995), Mosby Publications, India,Pp No:300-325.

• Polit D.F. Hugler Bp, “ESSENTIALS OF NURSING

RESEARCH”,Philadelphia,JB Lippincott Company(1999),.Pp No:40-45.

• Praveen Kumar et al; kumar & clark “ CLINICAL MEDICINE”; 6th edition;

Elsevier publication; pp no: 758-760.

• Rick Daniels et al; “CONTEMPORARY MEDICAL SURGICAL

NURSING”; 1st edition; Thomson Delmar publication; pp no: 867-872.

•Russell D. Metcalfe-Smith. “PERFORMING BASIC LIFE SUPPORT.

NURSING PRACTICE”, Clinical Research. 2003 Oct-7, 99(40); 20

• Suzanne C Smeltzer et al,. “MEDICAL SURGICAL NURSING”, 10th Ed. .

(2007), Philadelphia, LWW. 810-812.

• Wilma J Phipps et al; “ MEDICAL-SURGICAL NURSING”; 7th Edition;

B.I.Publishers; pp no:890-891

JOURNALS:

x American Heart Association Guidelines for CPR &Emergency

Cardiovascular care circulation 2005; 112:1V1-203

x Anil Kumar Parashar. Effective Planned Teaching Programme on Knowledge

& Practice of Basic Life Support among Students in Mangalore. THE

NURSING JOURNAL OF INDIA. February 2010-Feb, Vol. Cl No. 2.

x Bakhsh F (2010) Assessing The Need And Effect Of Updating The

Knowledge About Cardio-Pulmonary Resuscitation In Experts,

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. 4(3)

2511-14

x Benjamin S. Abella, he, Quality of cardiopulmonary resuscitation during

in hospital cardiac arrest. THE JOURNAL OF AMERICAN MEDICAL

ASSOCIATION. 2005 Jan 19; Vol.3: 293-98.

x BMY Cheung (2003) Knowledge of cardiopulmonary resuscitation among

the public in Hong Kong: telephone questionnaire survey. HONG KONG

MED J. 9(5). 323-28

x Dr. H. Shankar, “EFFECTIVENESS OF CPR IN HOSPITAL CARDIAC

ARREST”, 2008. Volume 17, issue 5, MADURAI MEENAKSHI

MISSION MEDICAL JOURNAL.

x Dr. Shantha Chandrasekaran and team, awareness of basic life support in

Vinayaka Mission Medical College Salem, 2010 March, volume 54(2), page

no: 121-126, INDIAN JOURNAL OF ANAESTHESIA.

x Eisenberg MS,Mengert T.J,Cardiac resuscitation,N.Eng J Med

2002;344:1034-13

x Hamilton R. (2005) Nurses' knowledge and skill retention following

cardiopulmonary resuscitation training: a review of the literature. J OF

ADVANCED NURSING, 51(3) 288-97

x Kuhnigk H, Sefrin. P, Paulus T (1994) Skills and self-assessment in cardio-

pulmonary resuscitation of the hospital nursing staff. EUROPEAN

JOURNAL OF EMERGENCY MEDICINE. 1(4) 193-8

x Lan H Kerridge, Sallie-Anne Pearson, Isobel E Rolfe and Michael Lowe,

Decision making in CPR: attitudes of hospital patients and healthcare

professional. THE MEDICAL JOURNAL OF AUSTRALIA. 1998; 169:

128-131.

x Losert H, Quality of cardiopulmonary resuscitation among highly trained

staff in an emergency department. Archives International Medicine. 2006

Nov 27; 166(21): 2375-80.

x Patricia Josipovic, Michael Webb, Ian Mc Grath. Basic Life Support

knowledge of undergraduate nursing and chiropractic students.

 AUSTRALIAN JOURNAL OF ADVANCED NURSING. 2009, 26(4); 58-

63.

x Sefrin P, Paulus T et al (1994) Resuscitation skills of hospital nursing staff.

Anesthetist 43(2) 107-14

x THE NURSING JOURNAL OF INDIA by TNAI, Feb 2010 Vol.CL.NO:2

x Thoren Ann-Britt , Axelsson Asa B, Herlitz Johan , Possibilities for, and

obstacles to, CPR training among cardiac care patients and their co-habitants.

Division of Cardiology. 2005; Volume 65. 337-343

x Vanderschmidt H, Burnap TK, EVALUATION OF

CARDIOPULMONARY RESUSCITATION COURSE FOR

SECONDARY SCHOOl. Med care 1975 Sep; 13(9): 763-74.

NET REFERENCES:

• http://www3.who.int/whosis/menu.cfm

• http://www.pubmed.com.

• http://www.timesofindia.com.

• http://www.indianjournal.com

• http://Wikipedia.org.

• www.webmd.com/heart-disease

• www.imaginis.com

• www.sign.ac.uk

• https://en.wikipedia.org/wik

• www.ncbi.nlm.nih.gov › NCBI › Literature › PubMed Central (PMC)

 • emedicine.medscape.com/article/151907-overview

ANNEXURE
 ANNEXURE - II
Letter seeking expert’s opinion and suggestion for the content
Validity of the tool used for the study.
From,

Reg No: 301312902,

II nd Year M.Sc Nursing, Anbu College of nursing,

M G R Nagar, Komarapalayam.

To

Forwarded through
Mrs.Latha,
Principal,Anbu College of nursing,
M G R Nagar, Komarapalayam.
Sub: Expert opinion for content validation of research tool.
Respected Sir/Madam,
I Reg No: 301312902 a post graduate student of Anbu College of nursing,
anticipate Your valuable self; if you would accept to validate my research tool on the
topic “A study to Assess the effectiveness of structured teaching programme on
knowledge regarding Cardio Pulmonary Resuscitation among degree students in
a selected college, Komarapalayam.”
It would be highly appreciable if you would kindly affirm your acceptance to
endorse your Valuable suggestions on this topic. I had attached the details of the study
along with the research tool.
Thanking you
Date: Yours faithfully,
Place: Komarapalayam Reg No: 301312902
 ANNEXURE - III

CONTENT VALIDITY CERTIFICATE

I hereby certify that I have validated the tool of Reg No: 301312902 II nd

Year M.Sc Nursing student who is undertaking, “Assess the effectiveness of

structured teaching programme on knowledge regarding Cardio Pulmonary

Resuscitation among degree students in a selected college, Komarapalayam.”

Place: Signature and seal of the

Expert.

Date: Name and Designation.

 ANNEXURE - IV
LIST OF EXPERTS WHO VALIDATED THE TOOL

• Dr.J.Priya ,M.D.,

Physician

Senior Asst.Surgeon

Govt Head Quarters Hospital

Erode.

• Mrs.S.Lakshmi Prabha M.Sc (N),

Professor & HOD

Dept. of Medical Surgical Nursing

VMACON

Salem.

• Mrs.P.Shanmugavadivu M.Sc (N),

Asst. Professor

Vellalar college of Nursing

Erode.

• Mrs.G.Juliet Nirmala Mary M.Sc (N).,

Asst. Professor

Anbu College of Nursing.

• Mrs .R.Gowri M.Sc (N).,

Asst. Professor

Anbu College of Nursing.

STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING CARDIOPULMONARY RESUSCITATION

Name of presenter : Ms.Anbu Epsi.J (301312902)

Topic : Cardiopulmonary Resuscitation

Group : Students studying Anbu Arts and Science

College, Komarapalayam.

Duration : 45 Minutes

Medium of Instruction : English

Method of teaching : Power point presentation

General Objective : The students will gain knowledge, attitude and skill regarding

CPR.
 TEACHING
OBJECTIVES CONTENTS LEARNING
ACTIVITY WITH AV
AIDS
HEART
INTRODUCTION:
The heart is a muscular organ about the size of a closed fist that functions as the
body’s circulatory pump. It takes in deoxygenated blood through the veins and
Introduce the topic delivers it to the lungs for oxygenation before pumping it into the various arteries
(which provide oxygen and nutrients to body tissues by transporting the blood Introducing the topic with
throughout the body). The heart is located in the thoracic cavity medial to the lungs help of Power point
and posterior to the sternum. presentation
On its superior end, the base of the heart is attached to the aorta, pulmonary
arteries and veins, and the vena cava. The inferior tip of the heart, known as the
apex, rests just superior to the diaphragm. The base of the heart is located along the
body’s midline with the apex pointing toward the left side. Because the heart points
to the left, about 2/3 of the heart’s mass is found on the left side of the body and the
other 1/3 is on the right.

ANATOMY OF HEART:
Pericardium
The heart sits within a fluid-filled cavity called the pericardial cavity.
Pericardium is a type of serous membrane that produces serous fluid to lubricate the
heart and prevent friction between the ever beating heart and its surrounding organs.
 Structure of the Heart Wall
The heart wall is made of 3 layers: pericardium, myocardium and endocardium.
• Epicardium. The epicardium is the outermost layer of the heart wall .
• Myocardium. The myocardium is the muscular middle layer of the heart
wall that contains the cardiac muscle tissue.
• Endocardium. Endocardium is the simple squamous endothelium layer
that lines the inside of the heart. lungs.
Describe the Lecturing about the topic
anatomy and Chambers of the Heart with the help of Power
physiology. The heart contains 4 chambers: the right atrium, left atrium, right ventricle, point presentation.
and left ventricle
Valves of the Heart
The heart functions by pumping blood both to the lungs and to the systems of the
body. The heart valves can be broken down into two types:
x atrioventricular and
x semilunar valves.
Conduction System of the Heart
The conduction system starts with the pacemaker of the heart—a small bundle
of cells known as the sinoatrial (SA) node. The SA node is located in the wall of the
right atrium inferior to the superior vena cava. The SA node is responsible for
setting the pace of the heart as a whole and directly signals the atria to contract. The
signal from the SA node is picked up by another mass of conductive tissue known as
the atrioventricular (AV) node.
The AV node is located in the right atrium in the inferior portion of the
interatrial septum. The AV node picks up the signal sent by the SA node and
transmits it through the atrioventricular (AV) bundle. The AV bundle is a strand of
conductive tissue that runs through the interatrial septum and into the
interventricular septum. The AV bundle splits into left and right branches in the
interventricular septum and continues running through the septum until they reach
the apex of the heart. Branching off from the left and right bundle branches are
many Purkinje fibers that carry the signal to the walls of the ventricles, stimulating
the cardiac muscle cells to contract in a coordinated manner to efficiently pump
blood out of the heart.
Physiology of the Heart
Coronary Systole and Diastole
At any given time the chambers of the heart may found in one of two states:
• Systole. During systole, cardiac muscle tissue is contracting to push blood
out of the chamber.

• Diastole. During diastole, the cardiac muscle cells relax to allow the chamber
to fill with blood. Blood pressure increases in the major arteries during
ventricular systole and decreases during ventricular diastole. This leads to
the 2 numbers associated with blood pressure—systolic blood pressure is the
higher number and diastolic blood pressure is the lower number. For
example, a blood pressure of 120/80 describes the systolic pressure (120)
and the diastolic pressure (80).
The Cardiac Cycle
The cardiac cycle includes all of the events that take place during one
heartbeat.
Blood Flow through the Heart
Deoxygenated blood returning from the body first enters the heart from the
superior and inferior vena cava. The blood enters the right atrium and is pumped
through the tricuspid valve into the right ventricle. From the right ventricle, the
 blood is pumped through the pulmonary semilunar valve into the pulmonary trunk.
The pulmonary trunk carries blood to the lungs where it releases carbon
dioxide and absorbs oxygen. The blood in the lungs returns to the heart through the
pulmonary veins. From the pulmonary veins, blood enters the heart again in the left
atrium.
The left atrium contracts to pump blood through the bicuspid (mitral) valve into the
left ventricle. The left ventricle pumps blood through the aortic semilunar valve into
the aorta. From the aorta, blood enters into systemic circulation throughout the body
tissues until it returns to the heart via the vena cava and the cycle repeats.
The Electrocardiogram
The electrocardiogram (also known as an EKG or ECG) is a non-invasive device
that measures and monitors the electrical activity of the heart through the skin.
Heart Sounds
The sounds of a normal heartbeat are known as “lubb” and “dupp” and are caused
by blood pushing on the valves of the heart.
Cardiac Output
Cardiac output (CO) is the volume of blood being pumped by the heart in one
minute. The equation used to find cardiac output is: CO = Stroke Volume x Heart
Rate

Stroke volume is the amount of blood pumped into the aorta during each ventricular
systole, usually measured in milliliters.

Heart rate is the number of heartbeats per minute. The average heart can push
Define Cardiac around 5 to 5.5 liters per minute at rest. A normal resting heart rate for adults ranges
arrest and its from 60 to 100 beats a minute.
Management
 CARDIAC ARREST: Explaining about the
cardiac arrest and its
DEFINITION:A Sudden Cardiac Death (SCD) attack is when there is an abrupt management with the
loss of heart function and can be due to a variety of heart conditions. help of powerpoint
presentation.
CAUSES:

Coronary heart disease is the leading cause of sudden cardiac arrest. Many
other cardiac and non-cardiac conditions also increase one's risk.

RISK FACTORS:

Smoking, Obesity,Family history, lack of physical exercise.

DIAGNOSTIC STUDIES:

A cardiac arrest is usually diagnosed clinically by the absence of a pulse. In

many cases lack of carotid pulse is the gold standard for diagnosing cardiac arrest,
but lack of a pulse (particularly in the peripheral pulses) may result from other
conditions (e.g.shock), or simply an error on the part of the rescuer

IMMEDIATE MANAGEMENT:

Sudden cardiac arrest may be treated via attempts at resuscitation. This is

usually carried out based upon Basic life support (BLS), Advanced cardiac life
support (ACLS), Cardiopulmonary Resuscitation (CPR).

Define CPR and

BLS.
CARDIO PULMONARY RESUSCITATION:
Describing about CPR
INTRODUCTION: and BLS with the help of
Cardiopulmonary resuscitation, commonly known as CPR, is an emergency Powerpoint presentation.
procedure performed in an effort to manually preserve intact brain function until
further measures are taken to restore spontaneous blood circulation and breathing in
a person who is in cardiac arrest.

BASIC LIFE SUPPORT:

Basic life support refers to maintain the airway, support respiration and
circulation without the use of equipment. Each year, a number of babies and
children will suffer with an accident or illness severe enough to stop their breathing
and leads to respiratory arrest. In a small number of these cases, it will even stop
their heart beating and leads to cardiac arrest. The best chance of ensuring their
survival is to give them emergency treatment known as cardiopulmonary
resuscitation (CPR). CPR can consist of many different things, but the initial, vital
part is Basic Life Support (BLS).
Basic life support is a type of medical care used on someone with a life-
threatening injury or condition until full medical care can be given. An emergency
responder or someone trained in BLS can provide this critical care. Basic life
support consists of cardiopulmonary resuscitation and, when available, defibrillation
using automated external defibrillators (AED). The keys to survival from sudden
cardiac arrest (SCA) are early recognition and treatment, specifically, immediate
initiation of excellent CPR and early defibrillation.
The ability to deliver Basic Life Support, and apply basic aspects of first aid,
are important community skills that have been shown to save lives.BLS includes
maintaining airway and supporting breathing and circulation without the help of any
equipment .It comprises of repagination of signs of sudden cardiac arrest, heart
attack ,stroke, obstruction of airway by a foreign body
Eplain about the
indications and
steps performed in
CPR. PURPOSES:
Its main purpose is to restore partial flow of oxygenated blood to the brain and Explained about CPR
heart. with the help of
Powerpoint presentation.
MOST INDICATIONS:
¾ Cardiac arrest(trauma)
¾ Respiratory arrest(drowning)
.
Indications :
¾ CPR should be performed immediately on any person who has become
unconscious and is found to be pulseless.
¾ Loss of effective cardiac activity is generally due to the spontaneous
initiation of a nonperfusing arrhythmia, sometimes referred to as a
malignant arrhythmia. The most common nonperfusing arrhythmias
include the following:

x Ventricular fibrillation (VF)

x Pulseless Ventricular activity
x Pulseless electrical activity
x Asystole
x Pulseless bradycardia

Contraindications:

The only absolute contraindication to CPR is a do-not-resuscitate (DNR) order

or other advanced directive indicating a person’s desire to not be resuscitated in the
event of cardiac arrest. A relative contraindication to performing CPR is if a
clinician justifiably feels that the intervention would be medically futile. Emergency
cardiac treatments no longer recommended include the following:

x Routine atropine for pulseless electrical activity (PEA)/asystole

x Cricoid pressure (with CPR)
x Airway suctioning for all newborns (except those with obvious obstruction)

Chance of receiving CPR in time:

CPR is likely to be effective only if commenced within 6 minutes after the

blood flow stop because permanent brain cell damage occurs when fresh blood
infuses the cells after that time, since the cells of the brain become dormant in as
little as 4–6 minutes in an oxygen deprived environment and, therefore, cannot
survive the reintroduction of oxygen in a traditional resuscitation.

EQUIPMENT:

CPR, in its most basic form, can be performed anywhere without the need for
specialized equipment. Universal precautions (ie, gloves, mask, gown) should be
taken. However, CPR is delivered without such protections in the vast majority of
patients who are resuscitated in the out-of-hospital setting, and no cases of disease
transmission via CPR delivery have been reported. Some hospitals and EMS
systems employ devices to provide mechanical chest compressions. A cardiac
defibrillator provides an electrical shock to the heart via 2 electrodes placed on the
patient’s torso and may restore the heart into a normal perfusing rhythm.

American Heart Association CPR guidelines:

In 2010, the Emergency Cardiovascular Care Committee (ECC) of the AHA

released the Association’s newest set of guideness for CPR. Changes for 2010
include the following :

• The initial sequence of steps is changed from ABC (airway, breathing, chest
compressions) to
• CAB (chest compressions, airway, breathing), except for newborns
• “Look, listen, and feel” is no longer recommended

TECHNIQUE:

In its full, standard form, CPR comprises the following 3 steps, performed in order:

x Chest compressions
x Airway
x Breathing
For lay rescuers, compression-only CPR (COCPR) is recommended.

Positioning for CPR is as follows:

x CPR is most easily and effectively performed by laying the patient supine on
a relatively hard surface, which allows effective compression of the sternum
x Delivery of CPR on a mattress or other soft material is generally less
effective
x The person giving compressions should be positioned high enough above the
patient to achieve sufficient leverage, so that he or she can use body weight
to adequately compress the chest

For an unconscious adult, CPR is initiated as follows:

 x Give 30 chest compressions
x Perform the head-tilt chin-lift maneuver to open the airway and determine if
the patient is breathing
x Before beginning ventilations, look in the patient’s mouth for a foreign body
blocking the airway

Chest compression

The provider should do the following:

x Place the heel of one hand on the patient’s sternum and the other hand on top
of the first, fingers interlaced
x Extend the elbows and the provider leans directly over the patient (see the
image below)
x Press down, compressing the chest at least 2 in (5 cm)
x Release the chest and allow it to recoil completely
x The compression depth for adults should be at least 2 inches (instead of up to
2 inches, as in the past)
 x The compression rate should be at least 100/min
x The key phrase for chest compression is, “Push hard and fast”
x Untrained bystanders should perform chest compression–only CPR
(COCPR)
x After 30 compressions, 2 breaths are given; however, an intubated patient
should receive continuous compressions while ventilations are given 8-10
times per minute
x This entire process is repeated until a pulse returns or the patient is
transferred to definitive care
x To prevent provider fatigue or injury, new providers should intervene every
2-3 minutes (ie, providers should swap out, giving the chest compressor a
rest while another rescuer continues CPR

Ventilation

If the patient is not breathing, 2 ventilations are given via the provider’s
mouth or a bag-valve-mask (BVM). If available, a barrier device (pocket mask or
face shield) should be used.

To perform the BVM or invasive airway technique, the provider does the following:

x Ensure a tight seal between the mask and the patient’s face
x Squeeze the bag with one hand for approximately 1 second, forcing at least
500 mL of air into the patient’s lungs

To perform the mouth-to-mouth technique, the provider does the following:

x Pinch the patient’s nostrils closed to assist with an airtight seal

x Put the mouth completely over the patient’s mouth

x After 30 chest compression, give 2 breaths (the 30:2 cycle of CPR)
x Give each breath for approximately 1 second with enough force to make the
patient’s chest rise
x Failure to observe chest rise indicates an inadequate mouth seal or airway
occlusion
 x After giving the 2 breaths, resume the CPR cycle

ACLS(Advanced Cardiac Life Support)

In the in-hospital setting or when a paramedic or other advanced provider is

present, ACLS guidelines call for a more robust approach to treatment of cardiac
arrest, including the following:

9 Drug intervention
9 ECG monitoring
9 Defibrillation
9 Invasive airway procedures

ADJUNCT DEVICES:

While several adjunctive devices are available, none other than defibrillation. as of
2010, have consistently been found to be better than standard CPR for out-of-
hospital cardiac arrest. These devices can be split into three broad groups: timing
devices' those that assist the rescuer to achieve the correct technique, especially
depth and speed of compressions; and those that take over the process completely.

DEFIBRILLATOR:

Defibrillation is a common treatment for life-threatening cardiac dysrhythmias,

ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists
of delivering a therapeutic dose of electrical energy to the heart with a device called
a defibrillator. This depolarizes a critical mass of the heart muscle, terminates the
dysrhythmia and allows normal sinus rhythm to be reestablished by the body's
natural pacemaker, in the sinoatrial node of the heart.

Complications:

x Fractures of ribs or the sternum from chest compression (widely considered

uncommon)
x Gastric insufflation from artificial respiration using noninvasive ventilation
methods (eg, mouth-to-mouth, BVM); this can lead to vomiting, with further
airway compromise or aspiration; insertion of an invasive airway prevents
this problem .